摘要
目的通过对左室结构参数、血液动力学参数、心功能级别改善及副作用发生率等指标进行比较,探讨血管紧张素转化酶抑制剂(angiotensin-converting enzyme inhibitor,ACEI)与血管紧张素受体阻滞剂(angiotensin receptor blocker,ARB)治疗充血性心力衰竭是否具有相似的疗效和安全性.方法计算机检索MEDLINE(1966～2004)、EMBASE(1989～2000)、Cochrane图书馆临床对照试验资料库(2004年第1期)、国际药学文摘(IPA)(1970～2004)、中国生物医学文献光盘数据库(1980～2003),纳入比较ACEI和ARB治疗充血性心力衰竭患者的随机对照试验,对纳入研究的方法学质量进行评价,并应用RevMan 4.2软件进行统计分析.结果共纳入17个随机对照试验.Meta分析结果表明,ACEI与ARB对于左室舒张末期内径、心输出量、心率、心功能级别改善等方面的作用差异无统计学意义(P＞0.05),ACEI与ARB治疗中产生副作用例数的合并效应量差异有统计学意义[RR 2.17,95%CI (1.53,3.07),P＜0.000 01].结论 ACEI与ARB两类药物对心功能和左室重构方面的作用差异无统计学意义;在药物安全性方面,ACEI较ARB副作用发生率更高,安全性更低,其差异有统计学意义.在充血性心力衰竭的治疗中,ARB可适用于对ACEI不能耐受的病例,上述结论对于临床用药具有很好的指导意义.
Objective To evaluate the efficacy and safety of angiotensin converting enzyme inhibitor (ACEI) on the left ventricular texture parameters, blood kinetics parameters, degree of cardiac function and rate of side effects of patients with heart failure when compared to angiotensin receptor blocker (ARB). Methods We searched MEDLINE (19662004), EMBASE (19892000), The Cochrane Library (Issue 1, 2004), IPA (19702004), and Chinese Biomedicine Database (19802003). The quality of included studies such as randomization, blinding, allocation concealment and loss of follow up was evaluated and meta analysis was performd by RevMan 4.2 software. Results Eighteen randomized controlled trials (RCTs) were included. The meta analysis of efficacy didnt show statistical significance when comparing the pooled effect size of left ventricular end diastolic diameter (LVEDD), cardiac output (CO), heart rate (HR), degree of cardiac function. The pooled RR rate of side effects was 2 17, 95%CI 1 53 to 3 07, P< 0 000 01 . Conclusions No evidence shows significant difference of ACEI group from ARB group in the improvement of cardiac function and left ventricle remodeling. The rate of side effects of ACEI is statistically higher than that of ARB.
出处
《中国循证医学杂志》
CSCD
2005年第3期196-205,250,共11页
Chinese Journal of Evidence-based Medicine
基金
北京大学 211工程循证医学学科群资助项目子课题 (编号: 93000 242156033)。
